MLN Matters® Number: MM6381
Related Change Request (CR) #: 6381
Related CR Release Date: April 24, 2009
Effective Date: July 1, 2009
Related CR Transmittal #: R106BP and R1717CP
Implementation Date: July 6, 2009
Provider Types Affected
Speech-Language Pathologists in Private Practice who wish to bill Palmetto GBA for services provided to Medicare beneficiaries.
What You Need to Know
CR 6381, from which this article is taken, announces that Medicare will begin paying for appropriate claims submitted by enrolled speech-language pathologists for services provided in private practice on or after July 1, 2009. See the Background section of this article for additional important details.
Background
Historically, Medicare could only pay for speech-language pathology (SLP) services if the services were billed by an enrolled provider or supplier of services. CR 6381announces that Section 143 of the Medicare Improvements for Patients and Provider’s Act of 2008 (MIPPA) has amended the Social Security Act to authorize:
- The Centers for Medicare & Medicaid Services (CMS) to enroll speech-language pathologists (SLP) as suppliers of Medicare services, consistent with the enrollment policies that apply to physical therapists and occupational therapists in private practice; and
- SLPs to begin billing Medicare for outpatient speech-language pathology services furnished in private practice beginning July 1, 2009
This amendment will allow SLPs in private practice to bill Medicare and receive direct payment for their services. CMS will begin enrolling SLPs on June 2, 2009 and will accept (and pay for) appropriate claims for services provided on or after July 1, 2009, by enrolled SLPs in private practice for dates of service beginning July 1, 2009.
Note: A therapist is considered to be in private practice if the therapist maintains office space at his or her own expense and furnishes services only in that space or in the patient’s home; or is employed by another supplier of services such as a physician or another therapist and furnishes services in settings where therapy is provided at the expense of that supplier.
You should be aware that:
- No other provider or supplier other than the skilled nursing facility (SNF) will be paid for these services during the time the beneficiary is in a covered Part A stay. For information regarding SNF consolidated billing see the Medicare Claims Processing Manual Chapter 6 (SNF Inpatient Part A Billing, Section 10 (Skilled Nursing Facility (SNF) Prospective Payment System (PPS) and Consolidated Billing Overview).
- The home health prospective payment system (HHPPS) requires home health agencies (HHA) to provide (either directly or under arrangements) all outpatient rehabilitation therapy services to beneficiaries receiving services under a home health plan of care (POC). No other provider or supplier will be paid for these services during the time the beneficiary is in a covered Part A stay.
For information regarding HH consolidated billing see the Medicare Claims Processing Manual Chapter 10 (Home Health Agency Billing), Section 20 (Home Health Prospective Payment System (HHPPS) Consolidated Billing).
In addition, note that Palmetto GBA will apply therapy caps and exceptions, as appropriate, to speech language pathology services rendered by speech language pathologists in private practice. Information regarding therapy caps and exceptions for 2009 is available in the MLN Matters article related to CR 6321.
Additional Information
You can find more information about the speech-language pathology private practice payment policy by going to CR 6381, which was issued in two transmittals. You will find the updated portions of Medicare manuals attached to these transmittals as follows:
If you have any questions, please contact our Provider Contact Center at our toll-free number (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.